Classification - Directed Treatment of Low Back Pain

描述（由申请人提供）：大多数人在成年后会经历腰痛（LBP），超过50%的经历过LBP发作的人会复发。尽管与管理这种情况相关的医疗保健费用很高，但没有发现任何治疗方法在改善通常持续的症状和相关残疾方面一直有效，更重要的是，减少复发。有人认为，缺乏任何一种治疗方法的支持是对LBP患者的异质群体进行研究的结果，需要一个将LBP患者分类为更同质群体的系统。最近，一个基于运动系统相关损伤的LBP分类系统已经被描述和测试。用于对LBP进行分类的损伤与运动和对齐的特定方向有关，这些运动和对齐始终与（1）临床检查和（2）功能活动期间的人的症状相关。本提案的主要目的是进行一项前瞻性、随机、对照临床试验，以确定在改善慢性LBP患者的短期和长期结局方面，根据患者特定的基于损伤的LBP分类指导的治疗是否比非特异性物理治疗护理更有效。本研究的具体目的是确定18个月期间分类特异性治疗与非特异性治疗对（1）包括症状在内的损伤的影响（强度、频率、持续时间、位置和复发）、临床检查测试中的运动和对齐障碍，以及标准化临床测试中的运动和对齐障碍的运动学，（2）用奥斯韦斯特里LBP问卷和Baecke习惯性活动问卷测量的功能限制，和（3）用SF-36和LBP相关活动限制天数测量的残疾。分类特异性治疗将强调（1）改变人在功能活动中对运动和对齐障碍的使用，（2）运动以减轻障碍，以及（3）教育以了解运动和对齐的特定方向如何有助于症状。非特异性物理治疗将包括一般躯干强化、躯干和四肢灵活性、身体力学教育和功能活动指导。还将检查预后因素。这项研究的结果对于LBP患者康复中使用的检查和治疗方法的决策具有重要意义，LBP通常是一种持续，复发和昂贵的疾病。

DESCRIPTION (provided by applicant): Most people will experience low back pain (LBP) during their adult lives and more than 50% of the people who experience an episode of LBP will have a recurrence. Despite the high health care costs associated with managing this condition, no treatment has been found to be consistently effective in improving the often persistent symptoms and related disability, and more importantly, curtailing the recurrences. It has been suggested that the lack of support of any one treatment is the result of studies being conducted on heterogeneous groups of people with LBP, and a system for classifying people with LBP into more homogeneous groups is needed. Recently, a system of classifying people with LBP based on movement-system related impairments has been described and tested. The impairments used to classify LBP are related to the specific directions of movements and alignments consistently related to the person's symptoms during (1) a clinical examination, and (2) functional activities. The primary purpose of this proposal is to conduct a prospective, randomized, controlled clinical trial to determine if treatment directed by a person's specific impairment- based LBP classification is more effective than non-specific physical therapy care in improving short- and long-term outcomes in people with chronic LBP. The specific aims of this study are to determine the effect of classification- specific treatment versus non-specific treatment across an 18 month period on (1) impairments which include symptoms (intensity, frequency, duration, location, and recurrences), movement and alignment impairments on clinical examination tests, and kinematics of movement and alignment impairments with standardized clinical tests, (2) functional limitations measured with the Oswestry LBP questionnaire and the Baecke Habitual Activity questionnaire, and (3) disability measured with the SF-36 and number of LBP-related activity limitations days. Classification-specific treatment will emphasize (1) changing the person's use of movement and alignment impairments in functional activities, (2) exercise to alleviate impairments, and (3) education to understand how specific directions of movements and alignments contribute to symptoms. The non-specific physical therapy treatment will include general trunk strengthening, trunk and extremity flexibility, and education about body mechanics and guidelines for performance of functional activities. Prognostic factors also will be examined. The findings from this study have important implications with regard to decisions made about examination and treatment methods used in rehabilitation of people with LBP, an often persistent, recurrent and costly condition.